IVs, Baker at Beverly, SIFs, and more ....

A Shortage of IV Resources ... and Medications

While the nationwide shortage of IV fluids through injection bags has been felt since Hurricane Maria disrupted many production facilities in Puerto Rico last September, some Massachusetts hospitals have also begun to refocus attention on the shortages of various basic medications.

Of particular IV concern is the ongoing shortage of sodium chloride 0.9% injection bags, which are smaller in size and are used to inject drugs intravenously in hospital and outpatient settings. Baxter Healthcare Corporation’s facilities in Puerto Rico that produce those bags were knocked out of operation by the hurricane and only recently resumed production.

Last November, the FDA temporarily allowed the importation of IV saline products from facilities outside of the U.S. and encouraged the expansion of production at existing facilities to meet shortfalls.

But the shortages have continued and worsened in recent weeks as incidents of flu have risen.  Hospitals are employing “conservation and adaptation strategies”, such as using larger IV bags in place of the smaller bags, which, in turn, has caused a shortage of the larger bags.  The American Hospital Association held a member call last Thursday to discuss the issue with Baxter, which said its operations on the island continue to improve, but that the overall situation in Puerto Rico is of concern.

As the IV-bag issue played out across the U.S., some member hospitals have reported to MHA another concern – sporadic supply shortfalls of a host of medications, ranging from antibiotics, basic KCL (potassium chloride), lorazepam (brand name Ativan), local anesthetics such as lidocaine or bupivacaine – among many others.  Some hospitals are reporting that the understandable focus on opioids such as morphine and hydromorphone (Dilaudid) has caused a shortage of these drugs as well, which has had an effect on pain management in controlled hospital settings.

Why are the shortages occurring? A review of drugs listed on the American Society of Health-System Pharmacists (ASHP) website shows that manufacturers often cite supply-and-demand issues, but often give no reason at all for the shortages.  Said one frustrated Massachusetts hospital pharmacy manager, “A big part of it seems to be drug companies buying up companies that make generic drugs, and then turning off the spigot to keep the prices up.”

SIFs May Work in Mass. but Federal Law is Impediment

Supervised injection facilities (SIFs) may be a way to drive down overdose deaths in the state, but the state’s Secretary of Health and Human Services says there may be a big roadblock to creating SIFs in Massachusetts – the federal government.

Secretary Marylou Sudders, appearing with Governor Charlie Baker on WGBH radio last Thursday to discuss the opioid crisis, said she believes SIFs could hold the potential for “harm reduction.”

But, she added, “The challenge is that it’s completely illegal federally ... so it's hard for me to sort of make the leap of how you actually do that in our state at this time. But I have not – this is my personal opinion – I have not dismissed it as something we may need to consider, particularly if we are in the midst of an opioid epidemic.”

The MHA Board of Trustees in May 2017 voted unanimously to advocate for the creation of SIFs, which are facilities where people can inject illicit drugs under the supervision of trained staff.  Currently, there are no legally authorized SIFs in the United States, but they currently exist in 10 countries (including Canada), with another country about to go live. Data from those facilities illustrates success in mortality prevention and enhanced participation in substance use disorder treatment. The Massachusetts Medical Society voted last April to endorse pursuing the creation of SIFs in Massachusetts. MHA’s Board voted to support the MMS proposal that calls for the creation of a pilot SIF under the direction and oversight of a state-led taskforce convened by a state authority, such as DPH.  MHA has also expressed its support for legislation (SB1081) filed by Sen. Will Brownsberger (D-Belmont) that would permit DPH to approve the implementation of safe injection facilities.

Baker Tweet from Beverly: Importance of EDs to Opioid Fight

Governor Charlie Baker was at Beverly Hospital last Thursday as part of his tour to drum up support for his second major opioid bill, which MHA supports and which will be heard before the Joint Committee on Mental Health, Substance Use & Recovery on Tuesday.

Baker tweeted a photo showing him with EOHHS Secretary Marylou Sudders and Howard Grant, J.D., M.D., the president & CEO of Beverly’s parent company Lahey Health.

The governor tweeted: “Today, we visited @beverlyhospital with @NrthShoreHealth to highlight their successful program that is helping people every day to not only get on the road to recovery- but to stay there by providing support from recovery coaches during their journey.

“Hospital emergency rooms are often the first line of defense for people seeking help for their substance misuse. That’s why emergency department recovery coaches are so important—they meet patients where they are and provide an immediate link to treatment.”

Baker highlighted provisions in his opioid bill that would seek to institute certification criteria for recovery coaches, tweeting, “By establishing credentialing standards for recovery coaches, we’re telling insurance companies that their services are necessary and a vital tool for keeping people in treatment and focused on their long-term recovery.”

Markey’s Fentanyl Interdiction Bill Signed into Law

President Donald Trump last Wednesday signed into law HR 2142, the “International Narcotics Trafficking Emergency Response by Detecting Incoming Contraband with Technology Act” (INTERDICT Act), which requires U.S. Customs and Border Protection to  increase the number of chemical screening devices used to interdict fentanyl and other narcotics illegally imported into the United States. The act, with a $9 million appropriation, calls for dedicating the appropriate number of personnel to interpret data collected by the devices.

U.S. Senator Edward Markey (D.– Mass.) authored the bill that received wide bipartisan support. At the Oval Office signing, Markey noted that of the 2,000-plus people in Massachusetts that died from opioid overdoses in 2016, approximately 1,700 had fentanyl in their systems.

Trump presented Markey with the pen he used to sign the bill. The next day, Markey tweeted a picture of the signing and handshake, and wrote, “THIS is the kind of border security we should be investing in, not wasting $18 billion on an ineffective wall that would stand as a symbol of hate.”

Work Requirement for Medicaid? Mass. Says, “No Thanks”

Last Thursday morning the Trump Administration announced it would allow state Medicaid programs to seek a Medicaid waiver that would allow states to require certain Medicaid beneficiaries to be either working, volunteering, or preparing to work as a requirement to receiving Medicaid.

In a letter to  state Medicaid directors, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services Brian Neale, wrote, “CMS will support state efforts to test incentives that make participation in work or other community engagement a requirement for continued Medicaid eligibility or coverage for certain adult Medicaid beneficiaries.”

The option to seek a CMS-approved work requirement would apply to “non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability.”  States would also have to create exemptions for those “medically frail” or with “acute medical conditions.” CMS also noted that individuals with opioid addiction and other substance abuse disorders would need access to Medicaid coverage and treatment. CMS reported that 10 states, including New Hampshire and Maine, are seeking a work requirement. 

By noon, the Baker Administration issued a statement to the State House News Service, stating, “The guidance was just released and we will assess accordingly as we do with any guidance, however the administration does not support applying work requirements to the MassHealth program. The Baker-Polito Administration is proud that Massachusetts remains a national leader in access to healthcare.”

CHIA Transparency Website in Beta Testing

The much-awaited-for consumer health information website from the state is up-and-running in test mode only; if all goes well during the beta review, CHIA expects to remove password protection from the website on or around February 14, and the public will then have access.

Chapter 224 required the state’s Center for Health Information & Analysis (CHIA), in consultation with other state agencies, to develop and maintain a consumer health information website displaying comparative information on cost and quality of healthcare services. The site has been in development and its roll-out delayed a few times.

Providers and other stakeholders are giving the site a test run and have until February 7 to deliver feedback to CHIA.

Save the Date: Mass. Adult Immunization Conference

Massachusetts DPH and the Mass. Adult Immunization Coalition will hold the 23rd Annual Mass. Adult Immunization Conference on Tuesday, April 10 from 8 a.m. to 4 p.m. at the Best Western Royal Plaza Hotel in Marlborough. Registration for the conference will begin in mid-February. The Massachusetts Adult Immunization Coalition (MAIC) is accepting nominations for the Massachusetts Adult Immunization Champion award, recognizing individuals or entities that have made an outstanding contribution to promoting adult immunization in Massachusetts. The deadline for the nomination is Friday, February 16. Visit here for more information about both the conference and award.

Project Management for Healthcare

Friday, March 16; 8:30 a.m. to 3 p.m.
MHA Conference Center, Burlington, Mass.

The fundamental purpose of project management is to be one step ahead of potential risk that could show itself during project planning and execution. The trick is to plan, organize, and control as many of the steps as possible to mitigate unnecessary consequences. This seminar is designed to do just that. It will provide participants with strategies that they can use right now, wherever they are in a project timeline. Whether it’s starting with the project plan or building the right team for the task, key strategies on time management, effective communication, and maintaining motivation will be presented. A “how to” related to workflow diagrams will be a significant takeaway as it’s the ultimate preparation tool to identify where current process breakdowns are occurring and to highlight areas that require more attention before implementation begins. Key tactics covering these critical topics and more will all be addressed in this one-day program.  Learn more by clicking here.

John LoDico, Editor